Sibbern Tonje, Bull Sellevold Vibeke, Steindal Simen A, Dale Craig, Watt-Watson Judy, Dihle Alfhild
Diakonhjemmet University College, Institute of Nursing and Health, Oslo, Norway.
Lovisenberg Diaconal University College, Oslo, Norway.
J Clin Nurs. 2017 May;26(9-10):1172-1188. doi: 10.1111/jocn.13456. Epub 2017 Feb 9.
To aggregate, interpret and synthesise findings from qualitative studies to further our knowledge regarding patients' pre- and postoperative experiences when participating in an enhanced recovery after surgery.
Numerous quantitative studies have documented benefits of participation in enhanced recovery after surgery programmes. Randomised control trials show that enhanced recovery after surgery reduce patient morbidity and shorten hospital length of stay. However, we presently have only sparse knowledge regarding patients' experiences of participating in these programmes.
A qualitative systematic review and meta-synthesis.
A systematic literature search of databases (Cinahl, Medline, PsycINFO, Ovid Nursing, and EMBASE) for qualitative studies published between 2000-2014 were undertaken. The identified studies were critically evaluated using the Critical Appraisal Skills Program, and patient experiences were synthesised into new themes by a team of researchers, using qualitative content analysis.
Eleven studies were included. Upon analysis, four main themes emerged: information transfer, individualised treatment vs. standardised care, balancing burdensome symptoms and expectations for rapid recovery, and sense of security at discharge. Information helped patients feel secure and prepared for surgery. Patients reported being motivated to participate in their recovery process. However, this became challenging when they faced symptoms such as pain, nausea, and weakness. Professional support fostered a feeling of security that was important in helping patients continue their regimen, recover, and be discharged as early as planned.
Patients in enhanced recovery after surgery programmes desired more consistency between pre- and postoperative information. Important opportunities exist to improve symptom management and help patients feel more secure about recovery postoperatively.
Nurses are in a unique position to improve communication of standardised regimens and enhance symptom management across the perioperative period. Clinical outreach, such as follow-up visits or phone calls, could target older adults who need additional assistance to meet enhanced recovery after surgery programme goals and derive benefit.
汇总、解读和综合定性研究的结果，以增进我们对患者参与术后加速康复时术前和术后体验的了解。
大量定量研究已证明参与术后加速康复计划的益处。随机对照试验表明，术后加速康复可降低患者发病率并缩短住院时间。然而，我们目前对患者参与这些计划的体验了解甚少。
定性系统评价与荟萃综合分析。
对2000年至2014年间发表的定性研究进行数据库（CINAHL、Medline、PsycINFO、Ovid Nursing和EMBASE）的系统文献检索。使用批判性评估技能计划对纳入的研究进行严格评估，一组研究人员采用定性内容分析法将患者体验综合为新的主题。
纳入11项研究。经分析，出现了四个主要主题：信息传递、个性化治疗与标准化护理、平衡令人困扰的症状与快速康复的期望、出院时的安全感。信息帮助患者感到安心并为手术做好准备。患者表示有动力参与康复过程。然而，当他们面临疼痛、恶心和虚弱等症状时，这变得具有挑战性。专业支持营造了一种安全感，这对于帮助患者继续治疗方案、康复并按计划尽早出院非常重要。
参与术后加速康复计划的患者希望术前和术后信息之间更加一致。存在改善症状管理并帮助患者对术后康复更有安全感的重要机会。
护士在改善标准化治疗方案的沟通以及加强围手术期症状管理方面具有独特地位。临床外展服务，如随访或电话回访，可针对需要额外帮助以实现术后加速康复计划目标并从中受益的老年人。
